title: Measles outbreaks in Micronesia, 1991 to 1994.
abstract: BACKGROUND
  Several islands in Micronesia experienced large measles outbreaks, during 1991 through 1994. Except for Guam, none of the islands had reported measles outbreaks during the previous 20 years.
  
  
  METHODS
  To characterize the outbreaks, measles surveillance data, hospital records and death certificates were reviewed. Preoutbreak vaccination coverage rates were assessed by reviewing public health vaccination records. Viral isolates were genetically sequenced to determine the source of transmission. Linear regression analysis was performed to assess the effectiveness of outbreak control measures.
  
  
  RESULTS
  Between 1991 and 1994 more than 1300 measles cases and 16 measles-related deaths were reported in Micronesia. Preoutbreak vaccination coverage rates among 2-year-old children were 55 to 94%. Genetic sequencing of the viral isolates and epidemiologic investigations suggested transmission between islands and new importations from outside of Micronesia. The highest attack rates were among children ages < 5 years (20/1000) and 10 to 19 years (38/1000). Compared with attack rates among children ages < 1 and 10 to 19 years, attack rates were lower among those ages 5 to 9 years, in whom 2-dose vaccination coverage rates were highest (P < 0.001). Early and rapid implementation of mass vaccination campaigns was significantly associated with shorter duration of outbreaks (P = 0.049).
  
  
  CONCLUSIONS
  The measles outbreaks in Micronesia show that island populations may be highly susceptible to measles. High two-dose vaccination coverage levels must be maintained to prevent such outbreaks. Early and rapidly implemented mass measles vaccination campaigns were effective in control of island outbreaks. Strengthening public health infrastructure and surveillance is necessary for early identification of outbreaks and rapid implementation of mass campaigns.
authors.affiliation: National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. dhm5@cdc.gov
authors.forename: D
authors.initials: D
authors.lastname: Güriş
authors.forename: S B
authors.initials: SB
authors.lastname: Auerbach
authors.forename: C
authors.initials: C
authors.lastname: Vitek
authors.forename: E
authors.initials: E
authors.lastname: Maes
authors.forename: J
authors.initials: J
authors.lastname: McCready
authors.forename: M
authors.initials: M
authors.lastname: Durand
authors.forename: K
authors.initials: K
authors.lastname: Cruz
authors.forename: K
authors.initials: K
authors.lastname: Iohp
authors.forename: R
authors.initials: R
authors.lastname: Haddock
authors.forename: J
authors.initials: J
authors.lastname: Rota
authors.forename: P
authors.initials: P
authors.lastname: Rota
authors.forename: J
authors.initials: J
authors.lastname: Heath
authors.forename: S C
authors.initials: SC
authors.lastname: Redd
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D006801:Humans; D007223:Infant; D008457:Measles / Q000453:epidemiology* / Q000517:prevention & control; D008458:Measles Vaccine / Q000276:immunology; D008849:Micronesia / Q000453:epidemiology; D013997:Time Factors; D014611:Vaccination
chemical_list: D008458:Measles Vaccine